Mental Health Resource Utilization in Individuals with Acute Traumatic and Nontraumatic Spinal Cord Injury with Mild or Moderate Depressive Symptoms

Research Objectives: To describe utilization of mental health services in a standard of care group of traumatic and non-traumatic spinal cord injury (SCI) patients with mild to moderate depressive symptoms following inpatient rehabilitation discharge within one year of injury.

Design: Single center, controlled, block randomized clinical trial.

Setting: Community-setting in California.

Participants: Twenty-nine adults with SCI and mild to moderate depressive symptoms (Patient Health Questionnaire 9 [PHQ-9] total scores between 5-14) and with Montreal Cognitive Assessment (MoCA) full scores ≥ 25 or MoCA Blind ≥ 18 were randomized into the standard of care group in a clinical trial. Participants were followed via phone to collect information on resources utilized after being discharged from acute inpatient rehabilitation over the course of 26 weeks.

Interventions: Not Applicable.

Main Outcome Measures: Clinical utilization survey of mental health services, antidepressant use, and other self-reported health conditions.

Results: The average age was 40 [SD]=17.1 and the majority were male (79.3%), traumatic etiologies (58.6%), with tetraplegia (51.7%), Caucasian (62.1%), and non-Hispanic (79.3%). The following general clinical utilizations were reported by the 29 participants: 96.6% had physician visits, 27.6% had ER visits, and 20.7% were hospitalized. Participants self-reported the following general health issues: 55.2% pain, 44.8% sleep disorders, 13.8% pressure sores, 10.3% Autonomic Dysreflexia, and 3.4% pneumonia. In terms of mental health utilizations, four participants reported at least 1 visit with a psychologist only, one participant had a visit with a psychiatrist only, and one participant had a visit with both. Participants also self-reported the following mental health related problems: sleep disorders (44.8%), depression (30.9%), and psychiatric disorders (6.9%). A total of 48.3% of participants reported anti-depression medication use.

Conclusions: In this sample less than 20% of participants utilized mental health services and under 50% used anti-depression medication post-discharge even though they endorsed mild to moderate depressive symptoms on the PHQ-9. Further research needs to be conducted to determine barriers or reasons for the lack of utilization of mental health services in individuals with SCI and generate alternatives they may be utilizing.

Author(s) Disclosures: None